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Stricture risk increased with delayed diagnosis of eosinophilic esophagitis
Patients with eosinophilic esophagitis should be diagnosed promptly because the prevalence of esophageal strictures corresponded directly with the time to diagnosis in a recent study.
Researchers conducted a retrospective analysis of 200 patients (median age at diagnosis, 39 years; 76.5% men) in Switzerland with symptomatic eosinophilic esophagitis (EoE).
Strictures, which commonly occur with EoE, were defined as “narrowing of the esophageal diameter, irrespective of the length of the stricture.” Researchers categorized stricture severity based on their ability to pass through a standardized adult endoscope. Through endoscopic findings and histologies on patients’ biopsies of the distal and proximal esophagus, researchers determined that 75 patients had strictures.
The median delay in diagnosing EoE was 6 years (interquartile range, 2-12 years), and as the delay increased, the prevalence of fibrotic features grew from 46.5% at 0 to 2 years to 87.5% at more than 20 years (P=.02). Greater diagnostic delays also corresponded with the prevalence of esophageal strictures. Prevalence ranged from 17.2% to 70.8% as delays extended from 0 to 2 years to more than 20 years (P<.001).
The researchers noted that “the prevalence of esophageal strictures positively correlated with the presence of endoscopic fibrotic features,” and also included corrugated rings and crepe paper esophagus.
“Our analysis … demonstrates that the prevalence of strictures is directly correlated with the length of the diagnostic delay,” the researchers concluded. “In addition, EoE patients are more likely to present with inflammatory endoscopic features early in the disease course and mostly develop fibrotic endoscopic features … as disease progresses.
“Measures should be undertaken to reduce the diagnostic delay in EoE.”
Disclosure: The researchers report no relevant financial disclosures.